Nepalese women with TB face unique challenges

Chhatra Karki, CNS Correspondent, Nepal
TB victimized Pabitra Tamang (name changed), a resident of a village in Dhading, Jawang, in the hilly region of Nepal, ten years ago. After being diagnosed with TB, she was deprived of proper medical treatment due to destitution of her family. To fuel the fire, her family started to torture her mentally instead of arranging for necessary medical treatment. After knowing her TB status, her husband abandoned her to marry another woman. Eventually, she was thrown out from her home by her family.
Following these events, Pabitra came to the capital city of Kathmandu, where she has been living alone ever since. She sustains her livelihood by working as a dish washer in a hotel. Her TB has still not been completely cured. She is afflicted with Multi-drug Resistant TB (MDR-TB). “I still carry TB with me. I could not get to take the medicines timely and regularly. That is why it is not cured,” Pabitra expressed her sorrow. “My husband left me. Poverty came in the way of my proper treatment. I have been maintaining my livelihood washing dishes in a hotel. If my employers come to know of my TB status, they will take away my job,” she said.

Pabitra is representative of the majority of TB affected women who have been victims of social discrimination and inequality. Fearing the social scoff, most of them do not even seek medical help. Even among those who go for treatment, many are deprived of regular medication due to poverty and lack of awareness. Therefore TB cases in Nepalese women are getting more complicated.

"TB-afflicted women are insulted by their family members, instead of being helped to get treatment. This disappoints them, as a result of which these women additionally suffer from anxiety, stress, and depression”, says Dr. Dirgha Singh Bom, Senior Pulmonary Disease and TB Specialist. Moreover, there is this superstition in remote villages of Nepal that TB is the accumulated result of one's bad deeds in previous life. Dr. Bom views that women in uneducated communities are more vulnerable to social discrimination.

TB is a critical public health issue in the Nepalese context. According to the National Tuberculosis Centre of the government of Nepal, 45% of Nepal’s total population is infected with TB. Every year 40,000 people add up as new patients of TB and 5000-7000 people lose their lives annually to this disease.

Dr. Bom informed that 60-65% of those who come to seek medical treatment for TB are males. He further explained, " The male-dominated societies in Nepal are still suppressive on women. The social status of women here is humiliating. The women in villages are deprived of their freedom. Health services are not accessible to them, and most yield to untimely deaths."

According to World Health Organization (WHO), TB is the third major cause of death in women globally. In 2013 alone, 3.3 million new cases of TB were diagnosed in women. In the same year 510000 women died from the disease, out of which 69% were from African and South-East Asian countries--countries with poor economic conditions. Experts view that the health complications are more when it comes to the females suffering from TB. Women with TB have twice the possibility of giving birth to a child with less weight.

Experts opine that women are highly vulnerable to TB due to their poor socio-economic conditions, lack of education and access to health services. In order to address these issues, they suggest qualitative health treatment to women suffering from TB and putting an end to the discrimination imposed on them. Paula Fujiwara, Scientific Director at department of Tuberculosis and HIV of the International Union Against Tuberculosis and Lung Disease (The Union), says, “TB needs to be taken seriously as a women's health issue because TB kills more than half a million women a year and makes more than 3 million women sick annually. And women with TB face unique challenges, including intense stigma and abandonment. They have a more challenging time accessing TB services than men do, typically. We need to reduce stigma by educating people about what TB really is. Anyone can get TB, rich or poor, man or woman. People with TB, including women with TB, deserve compassion and the best medical care available. We need to make it socially unacceptable to stigmatize people who are sick, with TB or with any other disease.”